International Journal of Urology最新文献

Objectives: Adrenocortical carcinoma (ACC) is a rare, aggressive tumor with high recurrence rates after surgery. Although radiotherapy (RT) has historically been underutilized in ACC, modern RT techniques have renewed interest in its potential role for improving local control (LC). This study evaluated long-term outcomes and prognostic factors in high-risk localized ACC treated with adjuvant RT and mitotane.

Methods: In this multicenter retrospective study, 23 patients with localized, high-risk ACC who underwent complete surgical resection followed by adjuvant RT between 2003 and 2023 were analyzed. All received mitotane, and 21.6% also received platinum-based chemotherapy. RT was delivered using image-guided IMRT or VMAT to a median dose of 50.4 Gy, targeting the tumor bed with or without regional lymphatics. Survival was estimated using the Kaplan-Meier method, and prognostic factors were assessed with Cox regression analyses.

Results: At a median follow-up of 84.7 months, the 5-year LC, overall survival (OS), and disease-free survival (DFS) rates were 85.5%, 58.6%, and 45.6%. Locoregional recurrence occurred in two patients (8.6%), with isolated local failure in one (4.3%). Distant metastasis (DM) developed in 47.8% and was the predominant failure pattern. On univariable analysis, age > 55 years predicted worse OS and DFS, while female sex independently predicted inferior DFS. Treatment was well tolerated, with no grade ≥ 3 RT-related toxicities.

Conclusions: Adjuvant RT achieves excellent LC with minimal toxicity in high-risk localized ACC. These exploratory findings, limited by small cohort size, retrospective design, and absence of a comparator group, warrant confirmation in larger prospective multicenter studies.

Objective: To compare survival outcomes between Japanese patients receiving radical cystectomy (RC) and intravesical Bacillus Calmette-Guérin (BCG) for high-risk non-muscle-invasive bladder cancer (HR-NMIBC).

Methods: This study was conducted within the Japanese Urological Oncology Group (JUOG) framework using two nationwide, multi-institutional databases: JUOG-UC-2021-RC, comprising 2674 patients with bladder cancer who underwent RC, and JUOG-UC-1901-BCG, comprising 3226 patients who received intravesical BCG. Patients were classified according to the Japanese Urological Association guideline (version 2023) risk stratification model into three cohorts: BCG-naïve standard HR-NMIBC (without aggressive factors), BCG-naïve highest-risk NMIBC (an aggressive subgroup), and BCG-unresponsive NMIBC. Metastasis-free survival (MFS) and overall survival (OS) were compared between the two interventions. Propensity score matching was applied to create well-balanced groups (BCG vs RC).

Results: In the adjusted BCG-naïve standard HR-NMIBC subcohort, both MFS and OS were longer in the BCG-treated group than in the RC group (p = 0.15 and p = 0.027, respectively). However, no significant differences in MFS or OS were observed in the adjusted BCG-naïve highest-risk NMIBC subcohort (p = 0.20 and p = 0.47, respectively). In the adjusted BCG-unresponsive NMIBC cohort, no differences in MFS or OS were detected (p = 0.76 and p = 0.35, respectively), although long-term survival outcomes appeared better in the salvage RC group than in the BCG rechallenge group.

Conclusions: Our findings demonstrated that the RC group had worse outcomes than the BCG group in the BCG-naïve standard HR-NMIBC subcohort but not in the highest-risk or BCG-unresponsive cohorts. Accumulating evidence is essential to guide physicians in counseling patients with HR-NMIBC and BCG-unresponsive NMIBC. REGISTRY AND THE REGISTRATION NO.

Of the study/trial: The authors have nothing to report.

Background: Male infertility is influenced by a variety of etiologies, including quantitative and qualitative impairments in spermatogenesis. Antioxidants scavenge reactive oxygen species (ROS), which reduce sperm motility, cause damage to DNA, and lead to subsequent apoptosis in sperm cells. This trial aimed to evaluate the effect of oral Synbiotic and a multivitamin-mineral supplement for men helping to improve male fertility (SperiGen), as an antioxidant agent, on the spermatogram in idiopathic Oligoasthenoteratozoospermia (iOAT).

Materials and methods: This double-blind randomized clinical trial was conducted on infertile males with iOAT. Totally, 73 patients with iOAT were blindly randomized into two groups; one group received SperiGen as an antioxidant agent in addition to placebo. In the next group, in addition to SperiGen, the patients received 500 mg Synbiotic (FamiLact) on a daily basis. They continued their treatments for 3 months. Semen parameters were measured before and after the intervention.

Results: Supplementations with a combination of Synbiotic and SperiGen compared with SperiGen and placebo significantly increased the average change of sperm progressive motility (p = 0.001), DNA fragmentation (p = 0.001), and diminished the levels of non-motile sperm (p = 0.018). Eventually, within-group analysis indicated that all parameters were significantly improved in both groups, except for non-progressive motility in the SperiGen and placebo group.

Conclusion: The combination of Synbiotic and SperiGen (an antioxidant supplement) appears to be much more effective than using an antioxidant alone in improving the DNA fragmentation, concentration, and progressive motility of sperm.

Trial registration: IRCT20190810044500N6, 2020-09-05. https://irct.behdasht.gov.ir/trial/46773. https://trial.medpath.com/clinical-trial/7ad7a7af5cba37f3/evaluating-symbiotic-therapy-male-infertility.

Objective: To validate the pubourethral stump angle (PUA), an MRI-based parameter, as a preoperative predictor of the need for an elaborate approach during delayed anastomotic urethroplasty (DAU) for pelvic fracture urethral injury (PFUI), using an independent cohort.

Methods: We retrospectively reviewed 184 consecutive male patients who underwent DAU for PFUI between August 2016 and August 2024 and had adequate preoperative pelvic MRI. Urethral anatomy was assessed by MRI using a standardized protocol. MRI parameters included PUA, urethral gap length, pubourethral stump length, lateral prostatic displacement, and dorsal venous complex patency. DAU was performed via a perineal approach with ancillary maneuvers applied stepwise: step 1 (bulbar urethral mobilization), step 2 (corporal separation), step 3 (partial pubectomy), and step 4 (supracrural rerouting). The approach was categorized as simple if completed up to step 2, and elaborate if step 3 or higher was required. Logistic regression was used to identify independent predictors, and predictive performance was assessed by the area under the ROC curve (AUC).

Results: An elaborate approach was required in 70 (38.0%). On multivariate analysis, prior transurethral treatment (OR 2.77, 95% CI 1.16-6.65, p = 0.02) and smaller PUA (OR 0.95 per degree, 95% CI 0.94-0.98, p < 0.0001) were independent predictors. The combined model demonstrated good discrimination, with an AUC of 0.782.

Conclusions: Smaller PUA on MRI and a history of prior transurethral treatment independently predict the need for elaborate surgical maneuvers during DAU for PFUI. Incorporating PUA into preoperative assessment may enhance surgical planning, facilitate patient counseling, and improve preparedness.

Objectives: Considering the high frequency of intravesical recurrence in bladder urothelial carcinoma (UBC), accurate non-invasive biomarkers for recurrence prediction are needed for better management after transurethral surgery. This pilot study examined the usefulness of urine DNA for detecting and predicting intravesical recurrence in UBC.

Methods: Patients with primary nonmuscle-invasive UBC were prospectively enrolled just after initial transurethral surgery. Genomic profiles were evaluated in resected specimens of the original tumor and in urine during follow-up. Urine DNA, urine cytology, and cystoscopy were all evaluated at 3-month intervals until 1 year postoperatively. Upon centrifuging urine samples into precipitation and supernatant fractions, we retrospectively evaluated urine DNA using a genomic panel established in our previous report.

Results: In the 19 patients enrolled, intravesical recurrent tumors were detected in six patients by cystoscopy. Urine DNA was positive in all of the recurrence cases before or at the time of cystoscopic or cytological detection, whereas urine cytology did not test positive before cystoscopic recurrence. Both urine precipitation and supernatant samples tested positive in 5 of 6 recurrence cases, indicating no obvious differences in the fraction used. Urine DNA was positive in 4 of the 13 nonrecurrence cases, among which three tested negative following Bacille Calmette-Guerin therapy.

Conclusions: Urine DNA as screened by our genomic panel may be useful for predicting and detecting intravesical recurrence in UBC. The simultaneous evaluation of urine precipitation and supernatant may enhance the clinical utility of urine DNA during surveillance for intravesical recurrence in UBC patients.